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Advocacy Update

Things are rolling now! Dave Renner and MAFP staff are keeping an eye on our issues as the Legislature’s policy committee deadlines passed on March 22 and 29, signaling the process by which legislative leaders winnow the volume of bills that remain viable for 2018. There is a third deadline in late April that applies to legislation with a tax or financial impact to the state.

Opioid Stewardship Bills Differ Greatly in the House and Senate
The Opiod Stewardship bills provide approximately $20 million in additional funding to address opioid abuse. The funding will be used to embed the Prescription Monitoring Program (PMP) into the electronic medical record to make it easier to use, provide grants to local communities to address opioid abuse and addiction, offer more education to prescribers and the public on the appropriate use of opioids, and assist counties in the increased costs of foster care for children of addicted parents. Both bills passed the HHS committees in their respective bodies and were referred to the finance committees.

The bills differ greatly in how they raise the funds. The Senate bill (SF 730) maintains the stewardship fee assessed on opioid manufacturers. This assessment, at times called the “penny a pill” assessment, along with an increase in the licensing fees on opioid distributers raises close to $28 million.

The House bill (HF 1440) removes the manufacturer assessments and allocated $20 million from the state’s General Fund for 2019, and an ongoing $15 million each year in the future. It is unclear whether this will be new money to the General Fund or whether this will come out of current appropriations to other programs.

Dose Limits
Included in the opioid legislation are opioid dose limits for treating acute pain. These limits are based on the guidelines that have been developed by the CDC and the Department of Human Services. In the House, they propose a seven-day limit on opioids for treating acute pain, while providing an exception if in the practitioner’s professional judgment more is needed to treat the patient. In this way, this is a treatment guideline, without telling the practitioner how a patient must be treated.

In the Senate version, the seven-day limit does not allow for professional judgment. Instead of a guideline, it is a strict practice standard. Regardless of what the treatment is, it is a bad precedent for the Legislature to adopt in law practice standards.

Mandatory PMP Check
Physicians have been successful in getting the message to legislators that the PMP is not an easy tool to use. It can take up to four to five minutes to log-in to the PMP and find the patient’s prescribing history. Both bills dedicate needed funds to embed it in the EMR. The Senate bill goes farther, however, also mandating that prior to prescribing any opioid with more than a three-day supply, the prescriber must first check the patient’s history in the PMP. There are no exceptions.

MAFP has been supportive of the stewardship bills, with concerns regarding the 7 day dose limited without exception for professional judgement and ensuring that the mandatory PMP check not add administrative burden by ensuring that the PMP is embedded into EMR.

Pharmacy Gag Clauses Prohibited
Thank you to those of you that took action recently by encouring your legislators to consider a series of bills that would help ensure prescription access and pricing transparency for patients. Two of the bills passed two House committees and one Senate committee last week. HF 3024 (Dean-R, Dellwood) would prohibit PBM contracts from telling pharmacists that they cannot tell patients it may be cheaper to not use their benefit and pay cash for their drug. These gag clauses are used to ensure that the drug prescribed is the one the PBM gets a rebate for.

The other bill, HF 3012 (Peterson-R, Burnsville) would ensure that the patients pays the lowest available price for the prescribe drug. Both bills are a first step in providing more transparency with drug pricing and how the PBM at times interferes with patient’s access to needed medication.

Under the bill (HF 3196), physicians would be authorized to override a step therapy requirement in three circumstances: 1) if a step requirement required the patient to use a drug that is medically contraindicated, 2) the patient has previously tried and failed a required drug therapy that is part of a step requirement and 3) if a patient’s condition is being successfully treated and it’s in the physician’s judgement that a change in therapy would likely be ineffective or cause the patient harm.

Rep. Kelly Fenton (R – Woodbury) and Sen. Paul Utke (Park Rapids) are the authors of the bills and are joined by numerous coauthors from both parties.

Medical Assistance Work Requirement Considered
Legislation to establish a work requirement for certain Medical Assistance (MA) recipients received its first hearing in the House HHS Reform Committee on March 20. Authored by Rep. Kelly Fenton (R – Woodbury), HF 3722 instructs the Commissioner of Human Services to apply for a waiver to implement a “work and community engagement requirement for able-bodies adults,” to receive health coverage through MA.

MAFP joined a coalition of nearly 100 groups representing providers, social services organizations, patient groups, and religious groups on a letter strongly opposing this bill. The letter stated: “Medicaid work requirements are costly, complex, bureaucratic, and will have unintended consequences for state and local government, health care providers, and Minnesotans receiving coverage from Medical Assistance in all corners of the state.”

The bill tries to define “able-bodied” but that definition does not include someone who is receiving mental health treatments. It would also create increased costs to providers to verify whether the person is meeting the requirement.

Gov. Mark Dayton has expressed his opposition to this legislation, so it is unclear whether he would sign it into law if it reaches his desk.

Apprentice Program for International Medical Graduates Moving
For many years, legislators have been trying to find a way to utilize foreign-trained physicians who do not qualify for licensure. There is an interest to put them to use to address physician shortages, especially in rural areas.

HF 2753 (Kiel-R, Crookston) would allow the Board of Medical Practice to issue a limited license to practice in rural or underserved communities to foreign-trained physicians who have not gone through an accredited residency program. This limited license would allow them to practice primary care only in an employed setting under supervision by another physician. Following practice under the limited license for two years, the individual would qualify for full medical license.

The bill is opposed by most physician groups, training programs, and the Board of Medical Practice. The BMP believes that to ensure minimum standards and protect the public, all physicians must complete at least one year of an accredited residency program.

The Senate version, SF 2310 (Abeler-R, Anoka) was amended in the Senate Health and Human Service Finance and Policy Committee to remove the apprentice model and standardize the residency requirements for both US-trained physicians and foreign-trained physicians. Under the bill, the requirement would be one year for both groups. Current law requires foreign-trained physicians to complete two years of residency before qualifying for licensure.

Tobacco Tax Inflator Considered
The House Tax Committee considered a proposal to reinstate the annual, automatic inflationary increase on the tax on tobacco products, as well as the premium cigar tax. Both provisions had been in place in state law prior to being repealed as part of the 2017 tax cut bill. Testifying in support of the proposal were representatives from the American Cancer Society and the Minnesotans for a Smoke-Free Generation, a tobacco control coalition that includes many health care advocates, including the MMA, the MNAAP, the MAFP, and dozens of others. Opponents include the tobacco industry, as well as retailers like gas stations, convenience stores, and tobacco-only shops.

The bill was laid on the table for possible inclusion in the tax omnibus, though its prospects look grim given that the majority so recently repealed these taxes.